R Ted Roberts DDS PA

Primary specialty

DentistTaxonomy code 122300000X

License

147071 Issued in MS

Legal business name

R TED ROBERTS DDS PA

Practice address

632 Friars Point Road
Clarksdale, MS 38614

Phone

(662) 624-6862

Fax

(662) 624-5985

NPI assigned

Sep 1, 2006

Organization subpart

No

Name

R Ted Roberts, DDS PA

Title

President

Phone

(662) 624-6862

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Theodore Roberts

  • General Practice Dentistry
  • Clarksdale, MS
  • NPI 1518083948
  NPD (past)

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164524328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 FRIARS POINT ROAD",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-624-6862",
            "fax_number": "662-624-5985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 FRIARS POINT ROAD",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-624-6862",
            "fax_number": "662-624-5985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R TED ROBERTS DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "TED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-624-6862",
        "authorized_official_credential": "DDS PA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "147071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03036322",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00062287",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirley Brianne Pounders, PHARMD
• Preferred Care Developmental Centers of Ms I, Inc.
• Kristalin Young Presley, FNP
• Professional Pharmacy Services, Inc
• R Andrew Packard MD PC
• Rad-One, PA
• Aisha Ragland
• Anu Ramgoolam, RD
• Preston Deshawn Ratiff III, PT
• RCG Mississippi, Inc.

• All providers in Clarksdale, MS
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.